The Spectrum Of Necrotizing Sialometaplasia- When to consider Surgical Intervention?

Objective: To describe the wide spectrum of clinical and microscopic manifestations of necrotizing sialometaplasia (NS). Methods: Retrospective review Results: The series reported included four cases, all female, 22-63 years old. The lesions were rapidly progressive, ulcerated swellings of the palate, associated with severe pain, 0.5 – 2.5cm in diameter. Two unilateral and two bilateral cases. Heavy smoking, anorexia/bulimia and drug/alcohol abuse were identified in three cases. The duration of three of the cases which were treated only by supportive care was 3-6 weeks. In case 4 with widespread necrosis surgical debridement was performed, palatal cover and antibiotic care. Complete healing was achieved within 12 weeks. In all cases a biopsy was taken to rule out malignancy and to support a diagnosis of NS. The biopsies showed a wide spectrum of microscopic changes, which included necrosis of salivary glands with preservation of the lobular pattern and diffuse inflammation in all cases. Diffuse yeast and bacterial colonization were observed in two cases. Squamous metaplasia of the salivary ducts was observed in only one case. Evidence for an ischemic event was found in case 4, showing complete occlusion of a large blood vessel at the periphery of the specimen by thrombocytes. This is the first reported case of NS with microscopic evidence for an ischemic event. Conclusions: NS presents a wide spectrum of both clinical and microscopic manifestations. Most cases are self-limiting and require only supportive care. In rare cases with wide spread necrosis, surgical debridement to prevent sepsis and to speed healing should be considered.